Haem Flashcards

Question

What do basophilic stippling on blood film point to?

Answer 1

Basophilic stippling (also known as punctate basophilia) is the blue staining of ribosomal precipitates within the cytoplasm of red blood cells. It is seen in megaloblastic anaemia, thalassaemias (in particular alpha thalassaemia), sideroblastic anaemia and alcohol abuse. A rare cause is the inherited disorder pyrimidine 5'-nucleotidase deficiency. Small numbers of affected cells may be a normal variant in some patients. In contrast to the polychromasia of reticulocytosis (which is also due to increased cytoplasmic rRNA), basophilic stippling suggests disturbed, rather than simply increased, red cell production.

Answer 2

Howell Jolly Bodies are remnants of the red blood cell nucleus, typically removed by the spleen. Their presence on a blood film suggests hyposplenism, which can be either functional (with the spleen in situ) or true (associated with splenectomy).

Answer 3

Schistocytes are fragments of red blood cells seen in microangiopathic haemolytic anaemia (MAHA). MAHA may be isolated, or associated with thrombotic microangiopathy syndromes (such as haemolytic uraemic syndrome and thrombotic thrombocytopenia purpura) or disseminated intravascular coagulation (DIC).

Answer 4

The number of lobes of the neutrophil nucleus can generally be used as an index of neutrophil maturity. Left shift describes the presence of immature cells (including so-called band cells - neutrophils with an unlobed, band-shaped nucleus), compared with right shift which describes hypermature neutrophils with >5 nuclear lobes. Left shift is primarily seen in acute infection Severe left shift (with the presence of myelocytes, promyelocytes and blasts) is more suggestive of myeloproliferative disorders such as chronic myeloid leukaemia, myelofibrosis or acute leukaemia.

Answer 5

A leukoerythroblastic film described to combined presence of immature (including nucleated) red blood cells and left shift (immature white cells). It is suggestive of marrow fibrosis or invasion, such as: primary myelofibrosis, metastatic cancer, TB and Gaucher's disease.

Answer 6

Anisocytosis is variation in red blood cell size, and quantified using the red cell distribution risk. The most common cause of anisocytosis with a low mean corpuscular volume is iron deficiency, but may also be caused by sickle cell anaemia, and more rarely by anaemia of chronic disease and thalassaemia (hence the need for confirmatory iron studies in this patient). In patients with an elevated mean corpuscular volume and anisocytosis, the differential would include: the megaloblastic anaemias, haemolysis with reticulocytosis, myelodysplasia and liver disease. It should also be remembered that a dimorphic anaemia (i.e. anaemia with two underlying causes) may present with a normal mean corpuscular volume and an elevated red cell distribution width.

Answer 7

Acanthocytes or spur cells (from the Greek “acantha”, meaning “thorn”) are red blood cells which appears irregularly spiked on a blood film. They are distinct from echinocytes (or burr cells) which are also spiked, but with smaller projections in a more regular distribution than those seen on acanthocytes. Acanthocytes occur due to altered lipid or protein composition of the red blood cell's plasma membrane. The two most important causes are liver disease and neuroacanthocytosis (including abetalipoproteinemia and homozygous familial hypobetalipoproteinemia); but anorexia nervosa, hypothyroidism and myelodysplasia have also been associated.

Answer 8

Cabot Rings are round red blood cell inclusions of unknown origin. They are slender loops seen in the cytoplasm of red cells in megaloblastic anaemia, severe anaemia of any cause, lead poisoning and leukaemia.

Answer 9

Echinocytes or burr cells (from the Greek “echinos”, meaning “hedgehog” or “sea urchin”) are red blood cells with small, regularly distributed projections across the cell surface. They are distinct from acanthocytes (or spur cells) which appears irregularly spiked or thorny. Echinocytes are thought to occur due to the extrinsic effect of changes in the composition of a patient's plasma. Causes include: liver disease, vitamin E deficiency, end-stage renal disease, and the haemolytic enzyme disorder pyruvate kinase deficiency.

Answer 10

Reticulocytes are immature red blood cells. Their presence on a blood film (or full blood count) typically indicates a high turnover of red cells, matched by increased marrow production and release. Examples of situations where this might occur include haemolysis and acute bleeding.

Answer 11

Target cells (also known as codocytes) are a relatively non-specific blood film finding. In contrast to spherocytes, which are thought to occur when the surface areas to volume ratio is reduced, target cells are thought to represent relative membrane excess. They are seen in obstructive liver disease, haemoglobinopathies (thalassaemia and sickle cell disease), and post-splenectomy. In addition, small numbers may be seen in iron deficiency anaemia.

Answer 12

Rouleaux are stacks of aggregated red blood cells. They occur when the plasma protein concentration is high, such as in multiple myeloma, as well as other paraproteinemias such as Waldenstrom's macroglobulinemia, inflammatory disorders and malignancies.

Answer 13

The four core features of which are hypercalcaemia, renal disease, bony lesions and anaemia.

Haem Flashcards

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